I am a 24 year old gay male living in San Francisco. I normally am very safe but I'm not perfect and I screwed up a few months back having unprotected sex with someone.

I took an HIV test a month after the encounter and the test was negative. Unfortunately, last week I took another test (it's now been 3 months since the encounter), and it came back positive.

Needless to say I'm still very upset and don't know what to do, but I am trying to sift through all this info about treatment and what not and I am hearing a lot of different things.

I found a doctor specializing in HIV and he is testing my blood for all sorts of levels and what not and to see what drugs my strain of HIV reacts to. He seems good so far. However, after calling around some more, I have found out three things:

1) There are vast differences in opinion between doctors on when to start treatment. How do I figure this out for myself? Is this just a gamble? I am only 24... I really don't want to die in 10 years. Should I start treatment now?

2) Apparently there are new treatments that can help if you were infected within the last 6 months. Is this true? What are these treatments? I figure I've been infected for 3 months, maybe 4.

3) Is HIV really a "chronic" illness vs. a death sentence now? I hear stories of people living "up to 20 years" - that only puts me at 44. Is there a chance of living longer? How will I know this and what questions should I ask my doctor to help me gauge this?

Sorry for such a long post.

- D

Response from Dr. Pierone

There are studies that suggest early treatment with HAART (generally defined as within 3 months of infection) may favorably impact the natural history of HIV infection. There is not one specific regimen; many different ones have been used. Prompt treatment of primary HIV infection is by no means a proven strategy; ongoing studies will help answer this important question.

There is a vast difference in opinion among doctors because we simply don't have the benefit of long-term scientific studies to guide us. The void produced by the absence of robust data leaves lots of room for different opinions. Beyond opinion, we do have some real world experience. In general, patients that choose early treatment do very well. But so do patients that choose deferred therapy.

HIV is a clearly a chronic manageable disease (for those with access to medication) that will play out over decades. We have only had highly active therapy for about 8 years, and really cannot predict forward 20 to 30 years with a great degree of accuracy. But if one extrapolates current experience into the future things look very promising whether one chooses immediate or deferred medications.

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